Showing papers in "journal of advances in medical education and professionalism in 2017"

The impact of the teachers' non-verbal communication on success in teaching.

Abstract: Introduction: Non-verbal communication skills, also called signlanguage or silent language, include all behaviors performed in thepresence of others or perceived either consciously or unconsciously.The main aim of this review article was to determine the effectof the teachers’ non-verbal communication on success in teachingusing the findings of the studies conducted on the relationshipbetween quality of teaching and the teachers’ use of non-verbalcommunication and also its impact on success in teaching.Methods: Considering the research method, i.e. a review article,we searched for all articles in this field using key words suchas success in teaching, verbal communication and non-verbalcommunication. In this study, we did not encode the articles.Results: The results of this revealed that there was a strongrelationship among the quality, amount and the method of usingnon-verbal communication by teachers while teaching. Based onthe findings of the studies reviewed, it was found that the morethe teachers used verbal and non-verbal communication, the moreefficacious their education and the students’ academic progresswere. Under non-verbal communication, some other patterns wereused. For example, emotive, team work, supportive, imaginative,purposive, and balanced communication using speech, body, andpictures all have been effective in students’ learning and academicsuccess. The teachers’ attention to the students’ non-verbalreactions and arranging the syllabus considering the students’mood and readiness have been emphasized in the studies reviewed.Conclusion: It was concluded that if this skill is practicedby teachers, it will have a positive and profound effect on thestudents’ mood. Non-verbal communication is highly reliable inthe communication process, so if the recipient of a message isbetween two contradictory verbal and nonverbal messages, logicdictates that we push him toward the non-verbal message and askhim to pay more attention to non-verbal than verbal messagesbecause non-verbal cues frequently reveal the intention of thesender of the information and reflect his/her emotional reactions.Based on the obtained results of this study, it is recommendedthat attention to non-verbal communication skills can make apositive change in the future of a student’s life. It seems necessaryfor the teachers to practice and learn effective communicationskills, especially for those who always interact with a largegroup of students. One of the factors contributing to the success or failure of students is the quality of the relationship and howthe teacher builds this relationship with students. Especially, itis more effective for students who are more responsive to humanrelations and communication skills. Finally, it is recommendedthat the teachers should improve their communication skills tohave better communication with their audience. The authoritiesare recommended to help improve the teachers’ level ofcommunication skills through holding training courses.Keywords: Communication; Teacher; Teaching

Empowering Education: A New Model for In-service Training of Nursing Staff.

Abstract: Introduction: In-service training of nurses plays an indispensablerole in improving the quality of inpatient care. Need to enhancethe effectiveness of in-service training of nurses is an inevitablerequirement. This study attempted to design a new optimal modelfor in-service training of nurses.Methods: This qualitative study was conducted in two stagesduring 2015-2016. In the first stage, the Grounded Theory wasadopted to explore the process of training 35 participating nurses.The sampling was initially purposeful and then theoretically basedon emerging concept. Data were collected through interview,observation and field notes. Moreover, the data were analyzedthrough Corbin-Strauss method and the data were coded throughMAXQDA-10. In the second stage, the findings were employedthrough Walker and Avant’s strategy for theory construction so asto design an optimal model for in-service training of nursing staff.Results: In the first stage, there were five major themes includingunsuccessful mandatory education, empowering education,organizational challenges of education, poor educationalmanagement, and educational-occupational resiliency.Empowering education was the core variable derived from theresearch, based on which a grounded theory was proposed. Thenew empowering education model was composed of self-directedlearning and practical learning. There are several strategiesto achieve empowering education, including the fostering ofsearching skills, clinical performance monitoring, motivationalfactors, participation in the design and implementation, andproblem-solving approach.Conclusion: Empowering education is a new model for in-servicetraining of nurses, which matches the training programs withandragogical needs and desirability of learning among the staff.Owing to its practical nature, the empowering education canfacilitate occupational tasks and achieving greater mastery ofprofessional skills among the nurses.Keywords: Grounded theory; Model; Nurse; Training

Models of clinical reasoning with a focus on general practice: A critical review.

Abstract: Introduction: Diagnosis lies at the heart of general practice.Every day general practitioners (GPs) visit patients with awide variety of complaints and concerns, with often minor butsometimes serious symptoms. General practice has many featureswhich differentiate it from specialty care setting, but during thelast four decades little attention was paid to clinical reasoningin general practice. Therefore, we aimed to critically review theclinical reasoning models with a focus on the clinical reasoningin general practice or clinical reasoning of general practitionersto find out to what extent the existing models explain the clinicalreasoning specially in primary care and also identity the gaps ofthe model for use in primary care settingsMethods: A systematic search to find models of clinical reasoningwere performed. To have more precision, we excluded the studiesthat focused on neurobiological aspects of reasoning, reasoningin disciplines other than medicine decision making or decisionanalysis on treatment or management plan. All the articles anddocuments were first scanned to see whether they include importantrelevant contents or any models. The selected studies whichdescribed a model of clinical reasoning in general practitioners orwith a focus on general practice were then reviewed and appraisalor critics of other authors on these models were included. Thereviewed documents on the model were synthesizedResults: Six models of clinical reasoning were identified includinghypothetic-deductive model, pattern recognition, a dual processdiagnostic reasoning model, pathway for clinical reasoning, anintegrative model of clinical reasoning, and model of diagnosticreasoning strategies in primary care. Only one model hadspecifically focused on general practitioners reasoning.Conclusion: A Model of clinical reasoning that included specificfeatures of general practice to better help the general practitionerswith the difficulties of clinical reasoning in this setting is needed.Keywords: Problem solving, General practitioners, Diagnosis

Self- directed learning barriers in a virtual environment: a qualitative study

Abstract: Introduction: There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. Methods: 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. Results: Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering), communication barriers (inadequate coping skills and inadequate writing skills) and educational environment barriers (heavy workload and role ambiguity). Conclusion: By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education. Keywords: Medical education; Graduate medical education; Technology; Learning

Learning style preferences: A study of pre-clinical medical students in Barbados.

Abstract: Introduction: Educators need to be aware of different learningstyles to effectively tailor instructional strategies and methodsto cater to the students’ learning needs and support a conductivelearning environment. The VARK [an acronym for visual (V),aural (A), read/write (R) and kinesthetic (K)] instrument isa useful model to assess learning styles. The aim of this studywas to use the VARK questionnaire to determine the learningstyles of pre-clinical medical students in order to compare theperceived and assessed learning style preferences, assess genderdifferences in learning style preferences, and determine whetherany relationships exists between awareness of learning styles andacademic grades, age, gender and learning modality.Methods: The VARK questionnaire was administered to preclinicalstudents taking a variety of courses in the first three yearsof the undergraduate MB BS degree programme at the Faculty ofMedical Sciences, The University of the West Indies, Cave HillCampus, Barbados in 2014.Results: The majority of the students were multimodal learnerswith no differences observed between males (59.5%) and females(60.0%), with tetramodal being the most common. Read/write(33.8%) followed by kinesthetic (32.5%) were the most commonlearning style preferences. The sensory modality preference forfemales was read/write (34.2%) and for males it was kinesthetic(40.5%). Significant differences were observed between theperceived and assessed learning style preferences with amajority of visual and read/write learners correctly matchingtheir perceived to their actual learning styles. Awareness oflearning styles was associated with learning modality but notwith academic performance, age or gender. Overall, 60.7% ofhigh achievers used multimodal learning compared to 56.9%low achievers.Conclusion: The findings from this study indicated that theVARK tool was useful in gathering information about differentlearning styles, and might assist educators in designing blendedteaching strategies to cater to the students’ needs as well as helpthe students in becoming aware of their learning style preferencesto enhance learning.Keywords: Education; Learning; Teaching; Medical students

Analyzing the Curriculum of the Faculty of Medicine, University of Gezira using Harden's 10 questions framework.

Abstract: Introduction: Despite the importance of curriculum analysisfor internal refinement of a programme, the approach for sucha step in under-described in the literature. This article describesthe analysis of the medical curriculum at the Faculty of Medicine,University of Gezira (FMUG). This analysis is crucial in the eraof innovative medical education since introducing new curriculaand curricular changes has become a common occurrence inmedical education worldwide.Methods: The curriculum analysis was qualitatively approachedusing descriptive analysis and adopting Harden’s 10 Questionsof curriculum development framework approach. AnsweringHarden’s questions reflects the fundamental curricular componentsand how the different aspects of a curriculum framework fittogether. The key features highlighted in the curriculum-relatedmaterial and literature have been presented.Results: The analysis of the curriculum of FMUG revealsa curriculum with interactive components. Clear structuredobjectives and goals reflect the faculty’s vision. The approachfor needs assessment is based on a scientific ground, and thecurriculum integrated contents have been set to meet national andinternational requirements. Adopting SPICES strategies helpsFMUG and students achieve the objectives of the curriculum.Multiple motivated instructional methods are adopted, fosteringcoping with the programme objectives and outcomes. A widerange of assessment methods has been adopted to assess thelearning outcomes of the curriculum correctly, reliably, and inalignment with the intended outcomes. The prevailing conduciveeducational environment of FMUG is favourable for its operationand profoundly influences the outcome of the programme. Andthere is a well-defined policy for curriculum management,monitoring and evaluation.Conclusion: Harden’s 10 questions are satisfactorily addressedby the multi-disciplinary and well-developed FMUG curriculum.The current curriculum supports the well-written faculty missionsand educational objectives. It presents a structured, conceptualframework that supports the validity of the assumption behind thecurriculum. The curriculum enhances intellectual and academicpursuits and supports social accountability.Keywords: Curriculum; Education; Medical; Problem-based learning; Program evaluation

Dynamics of self-directed learning in M.Sc. nursing students: A qualitative research.

Abstract: Introduction: Working in the complex and ever changinghealthcare settings forces the nurses and nursing students to beequipped with lifelong learning skills. One of the lifelong learningskills is self-directed learning. This study aimed to explore theM.Sc. nursing students’ self-directed learning activities.Methods: A qualitative design using conventional content analysisapproach was used in this study. Semi-structured interviews wereconducted with twelve Iranian M.Sc. nursing students who wereselected using purposive sampling.Results: Data analysis indicated that the M.Sc. nursing studentsperformed different activities in their self-directed learning.These activities were categorized into four main themes andten subthemes. The main themes were “sensory perceptions”,“knowledge construction”, “problem-centered orientation”, and“interaction with others”.Conclusion: According to the findings, the M.Sc. nursing studentsperformed different intellectual and experiential self-directedactivities for promoting their learning. Besides, the students’perseverance and inquisitiveness played an important role in theirself-directed learning in the challenging clinical environments.Keywords: Self-directed learning; Qualitative study; Nursing student

Addressing the physicians’ shortage in developing countries by accelerating and reforming the medical education: Is it possible?

Abstract: Introduction: Doctors’ shortage has remained a concernworldwide. The developed countries started aids to recruitinternational medical graduates (IMG) to cope with the defectsthat the health care system suffers from; however, this solution maynot work in developing countries that have a limited resource andpoor budget to spend on the health care system. This study aimsto present an alternative way to approach the physicians’ shortageby accelerating undergraduate medical education and reform somepost-graduate courses in order to cope with this problem.Methods: The literature in PubMed/Medline and Google scholarwere searched using such keywords as undergraduate medicaleducation, physician shortage, health care reform, physicians’performance, medical curriculum.Results: The finding revealed that performance duringundergraduate medical school does not have a relationship withthe physician’s performance post-graduation. Moreover, theoverloaded curriculum and the years spent in undergraduateeducation have a negative impact on the students in terms ofburn out, lack of competency, and loss of motivation in medicine.The method of education was found to have a positive effect onpreparing good students and ultimately good physicians.Conclusion: Since performance in undergraduate years does nothave an impact on the practice post-graduation, the developingcountries may consider the option of changing the context, andabbreviating undergraduate medical education as a solution forphysicians’ shortage dilemma. Moreover, modifying some postgraduatemajors such as family physician, and general practitionerto allow the physicians enter the practice in areas of need isrecommended.Keywords: Medical education; Physicians; Developing countries

Effect of formative evaluation using direct observation of procedural skills in assessment of postgraduate students of obstetrics and gynecology: Prospective study.

Abstract: Introduction: Direct Observation of Procedural Skills (DOPS) is a way of evaluating procedural skills through observation in the workplace. The purpose of this study was to assess the role of DOPS in teaching and assessment of postgraduate students and to know the effect of repeated DOPS on improvement of the skills and confidence of the students. Methods: This prospective study was conducted in the Obstetrics and Gynecology department of a rural tertiary centre in Northern India in two phases. All postgraduate students (n=20) were randomly divided year-wise into two groups, using lottery system such that both groups had equal number of first, second and third year students for didactic lecture/simulation teaching using mannequins, with hands-on exposure on Active management of third stage of labor (AMTSL) and Postpartum hemorrhage (PPH) management. In the first phase, Group 1 received simulation teaching using mannequins with hands on for 4 sittings, and Group 2 received didactic lecture on AMTSL. Following the students’ performance of AMTSL steps on delivering women, their competencies were assessed using DOPS structured checklist of ten points on 6 sessions. The students’ performance in six DOPS was compared between the two groups. In the 2nd phase, after flipping of the groups, group one received didactic lecture, and group 2 simulation teaching on PPH management with hands on for 4 sittings, followed by comparison of six DOPS performance in both groups. The data were analyzed by Wilcoxon rank-sum (Mann–Whitney) test using SPSS software, version 20. Results: In both phases, significant difference was observed between the two groups on first DOPS comparison (1st phase: p=0.000; 2nd phase: p=0.002), with simulation group performing better. Comparison of sixth DOPS in the two groups revealed no difference in both phases, but significant difference on first and sixth DOPS comparison in each group (p=0.000). Conclusion: Repeated DOPS results in improved skills and confidence of students in managing real life obstetric emergencies irrespective of the teaching modality. Keywords: Direct observation; Procedural skills; Postpartum hemorrhage; Clinical competency

Evaluation of information literacy status among medical students at Shiraz University of Medical Sciences

Abstract: Introduction: The information literacy status and the use ofinformation technology among students in the globalization age ofcourse plans are very momentous. This study aimed to evaluate theinformation literacy status and use of information technology amongmedical students of Shiraz University of Medical Sciences in 2013.Methods: This was a descriptive-analytical study with crosssectionalmethod. The study population consisted of all medicalstudents (physiopathology, externship and internship) studyingat Shiraz University of Medical Sciences. The sample size(n=310) was selected by systematic random sampling. Thetool of data gathering was LASSI questionnaire (assigned byAmerica research association) with 48 closed items in five-pointLIKERT scale. The questionnaire included two distinct parts ofdemographic questions and the information literacy skills basedon the standards of information literacy capacities for academiceducation. The content validity was acquired by professors’and experts’ comments. The reliability was also calculated byCronbach’s alpha (0.85). Data were analyzed in both descriptive(frequency- mean) and analytical level (t-test, analysis of variance)using SPSS 14 software.Results: 60.3% of the participants were females, and theremaining (29.7%) were males. The mean score of informationliteracy and its five subgroups among the students weren’t at adesirable level. The mean scores of information literacy foreducational grades from the highest to lowest belonged to theinternship, physiopathology and externship. The results showedthat the highest average was related to the effective access abilityto information among interns (9.27±3.57) and the lowest onewas related to the ability of understanding legal and economicalcases related with using information among externs (3.11±1.32).The results of ANOVA showed that there wasn’t a significantdifference between educational grades and information literacy.Finally, the result of independent t-test did not show a significantdifference between the two genders in information literacy.Conclusion: Regarding the importance of information literacy formedical students and undesirable status of information literacyamong students, the current educational plans will need to be revised.Keywords: Medical students; Information literacy; Technology; Medical informatics

Effectiveness of early clinical exposure in learning respiratory physiology among the newly entrant MBBS students

Abstract: Introduction: Early Clinical Exposure has been conceptualizedto orient medical students towards actual clinical scenario andhelp them correlate their theoretical knowledge with real lifesituations in early years of MBBS courses. In the present studywe explored the outcome of early clinical exposure in the contextof basic science topics (Physiology) in fresh MBBS entrantsand compared their performance with a conventionally taughtcontrol group.Methods: One hundred fifty voluntary students of 1st year MBBS(2015-16) batch consisted the sample of this study. They weredivided into two groups through the simple random method (usingcomputer generated random number table with roll numbers ofthe students). They were evaluated by MCQ (Multiple ChoiceQuestion) and OSCE (Objective Structured Clinical Examination)before and after being taught a basic Physiology topic (respiratorysystem) theoretically. The study group underwent clinicalexposure before the post-test while the control group did not.Performance of the students was compared between the twogroups by unpaired Student’s t-test whereas marks of pre and posttestwithin the same group were compared by paired student’s t–test. Everywhere p<0.05 was considered to be significant.Results: The marks of each group in the pre and post-testsdiffered significantly (p<0.05 in each case). Post-test markswere significantly greater in each group though the level ofimprovement was strikingly higher in the study group (p=0.01).Though there was no significant difference in pre-test marks ofboth groups (p=0.73), post-test marks were significantly higher inthe study group (p=0.04). Among the exposed students, majority(92%) opined that ECE was a better technique being practicallyoriented and more interesting while some (8%) found it to bemore time and energy-consuming, suitable for selective portionsof basic science topics.Conclusion: Early clinical exposure may be an effective techniqueto supplement the traditional theoretical teaching and improve theperformance of fresh medical entrants in Physiology. It has betteracceptability by the students and may be considered for inclusionin the existing pre-clinical curriculum with proper allocation oftime and manpower.Keywords: Early clinical exposure; Undergraduate; Curriculum

Effectiveness of resident as teacher curriculum in preparing emergency medicine residents for their teaching role

Abstract: Introduction: Over the past 30 years, recognizing the need and importance of training residents in teaching skills has resulted in several resident-as-teacher programs. The purpose of this study was to explore the impact of this teaching initiative and investigate the improvement in residents’ teaching skills through evaluating their satisfaction and perceived effectiveness as well as assessing medical students’ perception of the residents’ teaching quality. Methods: This research is a quasi-experimental study with pre- and post-tests, continuing from Dec 2010 to May 2011 in Imam Hospital, Tehran University of Medical Sciences. In this survey, Emergency Medicine Residents (n=32) participated in an 8-hour workshop. The program evaluation was performed based on Kirkpatrick’s model by evaluation of residents in two aspects: self-assessment and evaluation by interns who were trained by these residents. Content validity of the questionnaires was judged by experts and reliability was carried out by test re-test. The questionnaires were completed before and after the intervention. Paired sample t-test was applied to analyze the effect of RAT curriculum and workshop on the improvement of residents’ teaching skills based on their self-evaluation and Mann– Whitney U test was used to identify significant differences between the two evaluator groups before and after the workshop. Results: The results indicated that residents’ attitude towards their teaching ability was improved significantly after participating in the workshop (p<0.001). The result of residents’ evaluation by interns showed no significant difference before and after the workshop (p=0.07). Conclusion: On the whole, the educational workshop for Residents as Teacher for emergency medicine residents resulted in favorable outcomes in the second evaluated level of Kirkpatrick’s model, i.e. it showed measurable positive changes in the self-assessments of medical residents about different aspects of teaching ability and performance. However, implementing training sessions for resident physicians, although effective in improving their confidence and self-assessment of their teaching skills, seems to cause no positive change in the third evaluated level of Kirkpatrick’s model, i.e. the residents’ behaviors, and it does not seem to raise students’ satisfaction or meet their expectations. Keywords: Resident as teacher; Curriculum; Emergency medicine

Lifelong learning along the education and career continuum: meta-analysis of studies in health professions

Abstract: Introduction: Lifelong learning is an integral part of health professionals’ maintenance of competence. Several studies have examined the orientation toward lifelong learning at various stages of the education and career continuum; however, none has looked at changes throughout training and practice. The objective of the present study was to determine if there are differences between groups defined by their places on the education and career continuum. Methods: The authors performed a group-level meta-analysis on studies that used the 14-item Jefferson Scale of Physician Lifelong Learning or its variants. Eleven published articles, which reported on studies with post-secondary health professions students, residents, and practicing health professionals met the inclusion criteria. In total, there were 12 independent data sets, with four data sets per group. Results: In total, over seven thousand students, residents, and practicing health professionals responded to the Jefferson Scale (N=7.269). Individual study means tendency to be high, suggesting a high orientation toward lifelong learning among the trainees (students and residents) and practicing health professionals. Metaanalysis results indicated that the orientation toward lifelong learning tended to increase gradually along the education and career continuum. Significant differences in the group means were found between the trainees and practicing health professionals. Conclusions: In the reviewed studies, the orientation toward lifelong learning among students, residents, and practicing professionals was high. Nonetheless, although based on separate cohorts, it appears that the orientation toward lifelong learning continues to develop even after the completion of formal training. Keywords: Lifelong learning; Health professions; Meta-analysis

Program evaluation of an integrated basic science medical curriculum in Shiraz Medical School, using CIPP evaluation model

Abstract: Introduction: In recent years curriculum reform and integrationwas done in many medical schools. The integrated curriculum isa popular concept all over the world. In Shiraz medical school,the reform was initiated by stablishing the horizontal basicscience integration model and Early Clinical Exposure (ECE)for undergraduate medical education. The purpose of this studywas to provide the required data for the program evaluation ofthis curriculum for undergraduate medical students, using CIPPprogram evaluation model.Methods: This study is an analytic descriptive and triangulationmixed method study which was carried out in Shiraz MedicalSchool in 2012, based on the views of professors of basic sciencescourses and first and second year medical students. The studyevaluated the quality of the relationship between basic sciencesand clinical courses and the method of presenting such coursesbased on the Context, Input, Process and Product (CIPP) model.The tools for collecting data, both quantitatively and qualitatively,were some questionnaires, content analysis of portfolios, semistructuredinterview and brain storming sessions. For quantitativedata analysis, SPSS software, version 14, was used.Results: In the context evaluation by modified DREEMquestionnaire, 77.75%of the students believed that this educationalsystem encourages them to actively participate in classes. Courseschedule and atmosphere of class were reported suitable by 87.81%and 83.86% of students. In input domain that was measured by aresearcher made questionnaire, the facilities for education wereacceptable except for shortage of cadavers. In process evaluation,the quality of integrated modules presentation and Early ClinicalExposure (ECE) was good from the students’ viewpoint. Inproduct evaluation, students’ brain storming, students’ portfolioand semi-structured interview with faculties were done, showingsome positive aspects of integration and some areas that needimprovement.Conclusion: The main advantage of assessing an educationalprogram based on CIPP evaluation model is that the context, input,process and product of the program are viewed and evaluatedsystematically. This will help the educational authorities to makeproper decisions based on the weaknesses and strengths of theprogram on its continuation, cessation and revision. Based on the results of this study, the integrated basic sciences course forundergraduate medical students in Shiraz Medical School isat a desirable level. However, attempts to improve or reformsome sections and continual evaluation of the program and itsaccreditation seem to be necessary.Keywords: Integration; Medical students; Basic science; Curriculum

Presenting the Students' Academic Achievement Causal Model based on Goal Orientation

Abstract: Introduction: Several factors play a role in academic achievement, individual’s excellence and capability to do actions and tasks that the learner is in charge of in learning areas. The main goal of this study was to present academic achievement causal model based on the dimensions of goal orientation and learning approaches among the students of Medical Science and Dentistry courses in Guilan University of Medical Sciences in 2013. Methods: This study is based on a cross-sectional model. The participants included 175 first and second year students of the Medical and Dentistry schools in Guilan University of Medical Sciences selected by random cluster sampling [121 persons (69%) Medical Basic Science students and 54 (30.9%) Dentistry students]. The measurement tool included the Goal Orientation Scale of Bouffard and Study Process Questionnaire of Biggs and the students’ Grade Point Average. The study data were analyzed using Pearson correlation coefficient and structural equations modeling. SPSS 14 and Amos were used to analyze the data. Results: The results indicated a significant relationship between goal orientation and learning strategies (P<0.05). In addition, the results revealed that a significant relationship exists between learning strategies [Deep Learning (r=0.37, P<0.05), Surface Learning (r=-0.21, P<0.05)], and academic achievement. The suggested model of research is fitted to the data of the research. Conclusion: Results showed that the students’ academic achievement model fits with experimental data, so it can be used in learning principles which lead to students’ achievement in learning. Keywords: Goal, Orientation, Learning, Strategies, Academic achievement

Experiences of nursing students of Evidence-Based Practice Education according to Rogers' Diffusion of Innovation Model: A Directed Content Analysis

Abstract: Introduction: Evidence based practice (EBP) education isessential in promoting of clinical care, but an effective educationalstrategy for teaching EBP in nursing faculties is not available.The aim of this study was to explore the experiences of nursingstudents of EBP Education according to Rogers’ Diffusion ofInnovation Model.Methods: This qualitative study was carried out using a directedcontent analysis method and purposeful sampling. Data werecollected until saturation by fourteen semi-structured face-tofaceindividual interviews and two focus group discussions withnursing students from two nursing faculties in Tehran, Iran.Rogers’ Model was used in this study.Results: Data were classified into five themes and 11 categoriesaccording to the Rogers’s Model. Themes and main categorieswere knowledge (educational enrichment, new strategyfor education), persuasion (internalization of education,improvement of motivation), decision (acceptance, use in thefuture), implementation (objectivity, consolidation of learning)and confirmation (learning and teaching, achieving a goal, selfconfidence).Conclusions: EBP Education, based on the teaching strategyof Rogers’s Model, leads to an improved EBP learning. All thenecessary steps for a better education of it are included in thiseducational approach which can be used to teach any new subjectlike EBP.Keywords: Evidence based practice; Education; Nursing; Baccalaureate

Evidence-based medicine in pre-clinical years: a study of early introduction and usefulness.

Abstract: Introduction: Evidence Based Medicine (EBM) has established itself as a strong predictor of future medical practice by medical students. The purpose of this study was to determine the effectiveness of EBM in pre-clinical years and reflect on selfassessment skill of 4th semester medical students regarding the understanding of EBM and its various determinants. Methods: All of the 4th semester (MD4) medical students at the Avalon University of Medical School, Curacao who had completed their EBM curriculum were asked to voluntarily participate in a cross sectional student survey containing qualitative and quantitative questionnaires in a 10-point scale. The students’ responses were analyzed statistically and the results reported. Results: Twenty-three students participated in the survey. 91% of them reported that EBM had helped them to better understand research process and 95% believed that EBM was necessary to develop clinical skills in the future. 78% of the students agreed that they were provided with enough resources for effective implementation of EBM in the university. All participants (100%) self reported that they could appraise the research articles effectively (mean score 8.26, S.D-1.45). Conclusions: EBM is an integrative and comprehensive way to successfully adopt concepts of acquired medical knowledge for effective medical practice. Early introduction of EBM in preclinical years proved favorable in students and better equipped them with the ability to critically apprehend and appraise new research and innovations in medicine for optimal learning experience. There is a definitive need for scientific and systematic design of the curriculum for early introduction of EBM in pre-clinical years, best suited for the students. The principles should be directed towards further research for the effective implementation of EBM to enhance clinical skills. Keywords: Evidence-based medicine; Medical education; Medical students; Curriculum; Evaluation

Social Accountable Medical Education: A concept analysis.

Abstract: Introduction: Considering the pervasiveness of social accountablemedical education concept around the world and the growingtrend of literature in this regard as well as various interpretationsmade about this concept, we found it necessary to analyze theconcept of social accountable medical education.Methods: In this study, the modified version of McKenna’s approachto concept analysis was used to determine the concept, explainstructures and substructures and determine the border conceptsneighboring and against social accountability in medical education.Results: By studying the selected sources, the components ofthe concept were obtained to identify it and express an analyticdefinition of social accountability in medical education system.Then, a model case with all attributes of the given concept and thecontrary and related concepts were mentioned to determine theboundary between the main concept and auxiliary ones.Conclusion: According to the results of this study in the fieldof social accountability, the detailed and transparent analyticaldefinition of social accountable medical education can be used infuture studies as well as the function and evaluation of medicaleducation system.Keywords: Social accountability; Social responsibility; Social obligation; Medical education

The Impact of 3-Option Responses to Multiple-Choice Questions on Guessing Strategies and Cut Score Determinations.

Abstract: Introduction: Research has asserted MCQ items using threeresponse options (one correct answer with two distractors) iscomparable to, and possibly preferable over, traditional MCQitem formats consisting of four response options (e.g., one correctanswer with three distractors), or five response options (e.g., onecorrect answer with four distractors). Some medical educatorshave also adopted the practice of using 3-option responseson MCQ exams as a response to the difficulty experienced ingenerating additional plausible distractors. To date, however,little work has explored how 3-option responses might impactvalidity threats stemming from random guessing strategies,and what impact 3-option responses might have on cut-scoredeterminations, particularly in the context of medical educationclassroom assessments. The purpose of this work is to furtherexplore these critically important considerations that largely havegone ignored in the medical education literature to this point.Methods: A cumulative binomial distribution formula was usedto calculate the probability that an examinee will answer atrandom a given number of items correctly on any exam (of anylength). By way of a demonstration, a variety of scenarios werepresented to illustrate how examination length and the number ofresponse options impact examinees’ chances of passing a givenexamination, and how subsequent cut-score decisions may beimpacted by these factors.Results: As a general rule, classroom assessments containingfewer items should utilize traditional 4-option or 5-optionresponses, whereas assessments of greater length are affordedgreater flexibility in potentially utilizing 3-option responses.Conclusions: More research on items with 3-option responses isneeded to better understand what value, if any, 3-option responsestruly add to classroom assessments, and in what contexts potentialbenefits might be discernible.Keywords: Medical education; Assessment; Evaluation; Psychometrics

Medical students’ academic emotions: the role of perceived learning environment

Abstract: Introduction: Research shows that there is a relationship betweenstudents’ perceptions of classroom and learning environment andtheir cognitive, affective, emotional and behavioral outcomes, so,in this study the relationship between medical students’ perceptionof learning environment and academic emotions was examined.Methods: The research method used was descriptive-correlative.The statistical population consisted of medical students of ShirazUniversity of Medical Sciences. Stratified sampling methodwas used to select 342 participants. They completed self-reportquestionnaires of Dundee Ready Educational Environment Measure(DREEM) and Achievement Emotions Questionnaire (AEQ). Alldescriptive statistics, Pearson’s correlations and simultaneousmultiple regression were performed using SPSS 14 software.Results: Simultaneous multiple regression of the students’perceived learning environment on their academic achievementemotions showed that the perceived learning environment predictsthe students’ academic emotions.Conclusion: The results of this study revealed that caring forand supportive learning environment can increase the students’positive emotions and decrease their academic negative emotions(i.e. anxiety, shame, and hopelessness). Implications of the resultsare discussed.Keywords: Learning; Environment; Emotion; Medical students

Medical education in cyberspace: critical considerations in the health system.

Abstract: Introduction: Over the past few decades, two revolutionary approaches have emerged as a new form of medical education: Electronic Medical Education and Web-based Medical Education. A number of well-known medical institutions, such as Harvard and Johns Hopkins used a wide range of cyberspace capabilities to increase their competitiveness. Researchers have expressed that cyberspace will change health system’s main objective of training physicians and medical education. We conducted this study to identify the health system critical considerations on core issues, involving the development of medical education on cyberspace. Methods: In order to conduct this study, we observed the steps of a critical literature review, combined with the ‘Four-phase method’ adopted by Carnwell and Daly. We focused on particular literature on health and cyber system functions; it was associated with systemic approach. Results: We developed a six-level taxonomy, Cyber level, Governance level, Ministerial level, Organizational level, Program level and Performance level, as a key solution that can be applied for the success of medical education on cyberspace. The results were summarized and appraised in more details. Conclusion: Medical education on cyberspace is a complex interdisciplinary system. It is important that all aspects of the health systems be involved as integral to the development of cyber based medical education; without this convergence, we will be confused by the decisions made by others within the system. Health system should also communicate with those external sectors that are critical to achieving better learning on cyberspace. Integrated planning, governance and management of medical education in cyberspace are pivotal elements for the promotion. Keywords: Medical education; Educational technology; Health information technology; Health system

A Study on Capabilities Required In Military Medicine to Develop Modular Training Courses: A Qualitative Study.

Abstract: Introduction: The main mission of military medicine in the world is to support the health and treatment of the military in relation to issues, risks, injuries and diseases that arise due to the specific occupational conditions. The current study was carried out with the aim of determining the required skills of military physicians to define and determine the required training modules. Methods: The study was a qualitative research. Semi-structured interviews were used to collect the data and qualitative content analysis was used to analyze the data. The study population included all the professors and experts in the field of military medicine and medical sciences at the medical universities of Tehran. Snowball sampling technique was used to sample the study participants. Results: Based on the results, the required skills of military physicians in 5 categories and 29 sub- categories were identified; then based on the identified skills, 60 training modules at two introductory and advanced levels were determined including 39 introductory levels and 21 advanced levels. Conclusion: We can conclude that some of the important skills that military physicians need and can achieved through training have not been provided in any educational program and to achieve such skills and capabilities, other programs should be developed and modular training can be one of them Keywords: Medical education; Military medicine; Qualitative research

PhD supervisor-student relationship.

Abstract: Dear Editor, The relationship between the PhD supervisorand the PhD student is a complex one. Whenthis relationship is neither effective nor efficient,it may yield negative consequences, such asacademic failure (1).The intricacy of the supervisor-studentrelationship may be in part comparable to the onebetween the physician and his/her patient [see,for example (2)]. Both interactions develop overseveral years and the players involved in eachrelationship – PhD supervisor-student on the oneside and physician-patient on the other side – mayat some point of the journey develop differentexpectations of one another [see, for example (3,4)] and experience emotional distress (5).In both relationships, the perceived satisfactionwith the interaction will contribute to the successor failure of the treatment in one case, and inthe other, the writing of a thesis. To improve thementioned satisfaction, not only there is a needto invest time (6), as does the physician to his/her patients, but also both the supervisor andthe PhD student must be willing to negotiate aresearch path to follow that would be practicaland achievable. The communication between thephysician and patient is of paramount importancefor the provision of health care (7), and so is thecommunication between the supervisor and PhDstudent which encourages the progression of boththe research and the doctoral study (8).As to a smooth transition to the postgraduatelife, supervisors should start thinking aboutproviding the same kind of positive reinforcementthat every student is used to experience in theundergraduate course. The recognition for a jobwell done will mean a lot for a PhD student, asit does for a patient. One good example is theincrease in medication compliance by patientswith high blood pressure who receive positivereinforcement from their physicians (9).Supervisors can organize regular meetingsfor (and with) PhD students in order to not onlydiscuss their projects but also improve theircoping skills, including critical thinking andproblem-solving methods (5). The act of sharingknowledge and experiences can motivate the PhDstudents to persevere in their studies (10).When needed, supervisors should use theirpower of influence to increase the time that thestudent has available to devote to research whilemaintaining a part of their employment activities(health care‑related or not), since many PhDstudents are also full-time workers.Last but not least, supervisors and facultymembers must encourage PhD students topursue the available funding opportunities.Socioeconomic problems are known to be an issuefor PhD students (5). Without the supervisor’ssupport – by dealing with PhD student’s emotionsand personality –, research time, funding, and thestudent’s proactiviness, the doctoral journey may not attain success.

Interdisciplinary and inter-institutional differences in learning preferences among Malaysian medical and health sciences students.

Abstract: Introduction: The learner-centred approach in medical and healthsciences education makes the study of learning preferences relevant andimportant. This study aimed to investigate the interdisciplinary, interinstitutional, gender and racial differences in the preferred learningstyles among Malaysian medical and health sciences students in threeMalaysian universities, namely SEGi University (SEGi), University ofMalaya (UM) and Universiti Tunku Abdul Rahman (UTAR). It alsoinvestigated the differences in the preferred learning styles of thesestudents between high achievers and non-high achievers.Methods: This cross-sectional study was carried out on medical andhealth sciences students from three Malaysian universities following theapproval of the Research and Ethics Committee, SEGi University. Purposive sampling was used and the preferred learning styles were assessed using the VARK questionnaire. The questionnaire was validated prior to its use. Three disciplines (medicine, pharmacy and dentistry) were chosen based on their entry criteria and some similarities in their course structure. The three participating universities were Malaysian universities with a home-grown undergraduate entry medical program and students from a diverse cultural and socioeconomic background. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 22. VARK subscale scores were expressed as mean±standard deviation. Comparisons of the means were carried out using t-test or ANOVA. A p value of 0.05).Conclusion: This study gives an insight into the learner characteristicsof more than one medical school in Malaysia. Such multi-institutionalstudies are lacking in the published literature and this study gives abetter representation of the current situation in the learning preferencesamong medical students in Malaysia.Keywords: Learning; Medical students; Health sciences

Early clinical exposure program in learning renal physiology.

Abstract: Introduction: Teaching renal physiology for undergraduatemedical students in an understandable way using methods whichimprove their deep learning has always been a problem. In thisstudy, Early Clinical Exposure (ECE) was used in teaching renalphysiology for the second year medical students in Shiraz MedicalSchool. This article aims to introduce and develop this programand also measure the attitude of medical students toward ECE inlearning renal physiology.Methods: This is a mixed method study conducted on 120 secondyear undergraduate students. After performing the course, bothqualitative and quantitative methods were used for measuring theviewpoints of the students. In the qualitative part, 10 high rankmedical students were selected. These students participated inbrain storming sessions to express their opinion about the programbased on the strengths and weaknesses. For trustworthiness of thequalitative part, member check and peer check were done. In thequantitative part, a researcher-made questionnaire was used basedon the objectives of the program in a 4 point Likert scale. Thevalidity of questionnaire was determined by medical educationexperts and reliability was determined after a pilot study.Results: Based on the results of the quantitative part of the study,98 percent of the students stated that the ECE program wasgenerally a useful program. In the qualitative part, the students’comments were obtained. The benefits of the program weresummarized in 4 main themes. These themes are “understandingof renal physiology”, “Integration of basic and clinical knowledge”,“Improvement of attitude toward importance of physiology”, and“encouragement to study”. In response to the questions aboutnegetive aspects of this program in qualitative part, the two mainthemes were insufficient time and large grup size.Conclusion: Students reported that ECE was useful, but theystated that they needed to have more encounter with patientsand more hospital teaching. The results also reveal that this ECEprogram is an excellent approach to strengthen learning in adifficult subject like renal physiology. This approach is adjustableto other basic science topics and subjects as well.Keywords: Early clinical exposure; Integration; Learning

Fourth year medical students' reflective writing on "death of Ivan Ilych: a qualitative study.

Abstract: Introduction: Medical students should be familiar with the end of life ethical issues and its considerations. For teaching end of life care to medical students, literature is a source of excellent narratives of patients with experiences of terminally ill condition in their journey through suffering and one of the most favourite bioethics literature readings has been the death of Ivan Ilych by Tolstoy. We used this novel to show medical students end of life events and suffering and asked them to write a reflective essay on it. We aimed to find what students think about terminally ill patients and their journey to death. Methods: In an inductive qualitative content analysis model, 350 essays, collected by homogenous sampling, were analyzed. The fourth year medical students were provided with the Death of Ivan Ilych novel to read. They were asked to write a reflection essay based on the reflective stages defined by Sandars. These essays served as the unit of analysis, each being read several times and a coding model was formed according to main topics. The related concepts in each unit were named as themes and each theme was abstracted to a code and the related codes were compared and developed as categories. Results: Qualitative content analysis of 350 essays of fourth year medical students revealed three major categories in students’ reflection on reading Death of Ivan Ilych as an end of life human body. These included: 1) Emotional experience, 2) Empathy and effective communication, 3) Spirituality and dignity. Analysis of essays showed that this reflection activity may help medical students have a deeper idea of the end of life situation and feelings. Conclusion: This project suggests that literature can be used as an example to introduce new ethical concepts to less experienced medical trainees. The students acquired the concept of the story and reflected the major aspects of the suffering of a human being in their essays. Having used and evaluated the effect of literature on facilitating ethical insight in the teaching end of life care, we strongly recommend this method and specially the novella, Death of Ivan Ilych. Keywords: Education; Death; Medical students; Qualitative study

Comparison of the learning of two notations: A pilot study.

Abstract: Introduction: MICAP is a new notation in which the teeth are indicated by letters (I-incisor, C-canine, P-premolar, M-molar) and numbers [1,2,3] which are written superscript and subscript on the relevant letters. FDI tooth notation is a two digit system where one digit shows quadrant and the second one shows the tooth of the quadrant. This study aimed to compare the short term retention of knowledge of two notation systems (FDI two digit system and MICAP notation) by lecture method. Methods: Undergraduate students [N=80] of three schools participated in a cross-over study. Two theory-driven classroom based lectures on MICAP notation and FDI notation were delivered separately. Data were collected using eight randomly selected permanent teeth to be written in MICAP format and FDI format at pretest (before the lecture), post-test I (immediately after lecture) and post-test II (one week after the lecture). Analysis was done by SPSS version 20.0 using repeated measures ANCOVA and independent t-test. Results: The results of pre-test and post-test I were similar for FDI education. Similar results were found between post-test I and post-test II for MICAP and FDI notations. Conclusion: The study findings indicated that the two notations (FDI and MICAP) were equally mind cognitive. However, the sample size used in this study may not reflect the global scenario. Therefore, we suggest more studies to be performed for prospective adaptation of MICAP in dental curriculum. Keywords: Lecture; Pre-test; Post-test; Tooth

Evidence-based practice in Physiotherapy curricula: A survey of Indian Health Science Universities.

Abstract: Introduction: Evidence-based practice (EBP) is the conscientious,explicit and judicious use of the current evidence in clinicaldecision making. The physiotherapy profession has expressed acommitment to the development and use of evidence. However,very little is known about the extent to which EBP is integrated inphysiotherapy curricula in India. The purpose of this study wasto describe integration of EBP in Indian physiotherapy programs.Methods: An observational study was conducted where a reviewof curricula of all Health Science Universities (HSU) in India,offering an undergraduate (UG) and post-graduate (PG) degreeprogram in physical therapy was conducted using a data abstractionsheet. It gathered data on inclusion of research components ofEBP in the curricula, content and hours of teaching EBP, andassessment methods. Data were analyzed descriptively.Results: Curricula of fifteen HSU offering physiotherapy programswere reviewed. Contents relevant to EBP were incorporatedfrom the 2nd yr to final year. Common courses included researchmethodology (84.61%), research project (69.23%) and clinicalmanagement subjects (57.14%). No guidelines were given aboutadopting EBP in clinical practice. Didactic lectures were the modeof teaching (81.81%). Preferred method for assessing researchprojects was viva (44.44%). Critical appraisal was least includedin the entry level education. Contents relevant to all the five stepsof EBP were included in PG curricula.Conclusions: Though physiotherapy programs are introducing EBPteaching at the entry level, it lacks structured systematic approachand is fragmented. There is inadequate emphasis on clinicaloriented teaching of EBP and assessment methods. Moreover, thereis adequate coverage of EBP content in PG curricula.Keywords: Evidence based practice; Physiotherapy; Curriculum

Designing a System of Mentorship in Shiraz University of Medical Sciences.

Abstract: As you know, one of the new programs ofthe medical universities is to familiarizethe students to the medical atmosphere withthe help of compassionate and experienceduniversity professors. The program is plannedand implemented under the title of mentorship,in which an experienced instructor takes theresponsibility of orientation, guidance and problemsolving of a number of students. The studentsat the time of admission face some problems,usually due to the young age, unfamiliarity withthe university context, the amount of the texts,etc.; therefore, they feel somehow defenselessin this atmosphere. In this program, which waslongitudinal and often causes a long-term andfriendly relationship between the professor andstudents during the education years, these problemsof students discuss with teachers (Mentor) andin this interact somewhat elevated. To do theappropriate implementation of this concept inthe university, the university was required to befamiliar with the concept of mentorship at the firststep (1). So, the Education Development Center ofShiraz University of Medical Sciences (EDC) hasimplemented this issue in a series of educationalfellowship workshops for the professors ofpostgraduate levels.In teaching this concept, the Jowhari model(Joseph Luft and Harry Ingham famous model)(2) has attracted the attention of authoritiesand professors of this period. In educating theconcept of mentoring, the development of selfgeneralizationwindow of the professors wasconsidered. Because this section covers theability of communication and flexibility in theleadership of the individuals, development ofthe window (area) decreases the incidence ofconflicts and misunderstandings and strugglesbetween individuals in this regard. To developthis area, there was an attempt in this period thatthe professors get familiar with the two methodsof self-openness and feedback. This educationalprogram was a pilot which was implementedin the country for the first time in one of thefellowship programs for the faculty members.Then, according to the results and positivefeedbacks, it was applied more extensively. Sofar, this subject has been trained in 5 differentfellowship training courses of the professors inthe form of diverse topics, such as the mentorshipconcept in educating the students, counseling andmentoring models and evaluation and feedbackprinciples. The results of the training showsachievement of the educational goals (85%),applicability of the educational materials (93%),and relevance of the educational environment (78%) in the universities. So, due to the newnessof this concept in the country and the necessityof its performance, doing more studies onthe improvement of this concept in the otherprofessor of this university seems necessary.

The effect of gender bias on medical students and career choices: a cross-sectional study

Abstract: Gender equality amongst healthcare professionals is no doubt paramount to allow both equal opportunity and provision of good quality healthcare. The General Medical Council encourages that all colleagues should be treated fairly, but studies have previously demonstrated gender bias against female medical students (1). Whether this might have any impact on the students’ decision-making process and career pathways has yet to be explored. We aimed to evaluate whether doctors gave students gender-specific advice and the extent to which this advice influenced the students. Furthermore, we explored whether students felt their gender affected their career choices. We carried out a cross-sectional national study of British clinical medical students. A standardised questionnaire was completed by 94 students (54.3% female). The response rate was 88.7%. Results showed that 43.6% (n=41) of students received career advice based purely on their gender, and 63.4% (n=26) of these said that this would influence their career choices. Importantly, 82.9% (n=34) of the students who received gender-specific advice were female. Additionally, 41.2% (n=21) of females felt their gender would restrict their career choices compared with only 11.6% (n=5) of males (p=0.00142). 37.3% (n=19) of females thought their gender would unfairly disadvantage their career progression compared to 4.65% (n=2) of males (p=0.00016). Our results highlighted that doctors gave more gender-specific advice to females compared to males, and that this advice significantly impacts students’ decision making process. Furthermore, females disproportionately felt their careers would be disadvantaged and restricted compared with males. This shows an enormous disparity between male and female attitudes towards medical careers. This can have both long and short-term effects on training, career choices and patient interaction. Further research investigating why females feel their gender will restrict their careers, and why doctors give gender-specific advice, particularly targeted at females must be undertaken to identify the root cause of the problem. We therefore advocate that medical schools: 1) promote gender equality through seminars, talks and increase accessibility to good female role models; and 2) train clinical teachers to impart generic career advice as opposed to genderspecific career advice.